Disciplines in Disarray - Scope of Practice, Disciplinary boundaries

To be in a state of disarray, is to be disarmed, without access to resources, or at least having an impaired ability to organise strategically for reasons of defence, disputation or argument. Constructive debate will be hard to achieve and so the confusion continues.

Prior to 2013 ideas for a paper with a would-be co-author began. Early that year there were 5000 words. There's probably mention of (another!) project on these pages – somewhere/when? The focus was using Hodges' model to explore 'scope of practice' in nursing. As the conceptual gift that keeps giving, Hodges' model can encompass all health disciplines, curricula, and professions, informal caring and social care too.

This post is prompt-ed (human ‘intelligence’ needs a nudge too) by ‘discussion’ on what was twitter, and currently on ‘X’. So in turn I can reflect on how relevant this paper would be today.

I still have that draft of over 5000 words. It is now woefully out-of-date. Out-of-date? Well the available job postings across the health and care sectors, have always changed. If you scan the paper copies of  Nursing Times, Nursing Standard, Nursing Mirror (anyone?) and the BMJ, The Lancet, Health Service Journal over three-four decades the evidence is clear. Then try the e-media, (and with it AI!)?

Now, for several years the impacts of  policy and change in advanced nursing practice, plus associate roles, that have also been applied in medical training and education are coming home to roost. Depending on your corner, and position in the debate there's a position called 'Noctor' (Vaughan and Kar, 2026).

I find it regrettable that consultants and 'senior' nurses have taken corners, as policy results in grossly negative examples with potentially safety consequences. There has always been a 'distance' to be bridged between health disciplines. In the past any sense of competition was usually, and so constructively patient-centred - grounded in the delivery and quality of care. The contest was tempered through mutual respect and dignity, and recognition of respective roles, knowledge, abilities and contribution to what is (and remains?) the multidisciplinary team?

Now with technology and AI in the mix, maintaining goodwill, common-sense and keeping the patient, public and future generations in sight will need a degree of diplomacy as yet not called-upon.

This made me think of the unions in the 1970s and more recent examples of work-to-rule. 

As health professionals argue between themselves, what is the cost of distraction?

Yes, that paper using Hodges' model on 'scope of practice (and theory!)' would be timely now.
In fact, it is urgently needed.

Vaughan L, Kar P. Vexatious complaints are being weaponised to discourage debate BMJ 2026; 394 :e100697 doi:10.1136/bmj-2026-100697 

Previously: 'scope' : 'publications'

viii Book: Bill Ross - 'Order and the Virtual'

 'The Philosophy and Science of Deleuzian Cosmology'

So much of what we experience is nuanced. What was conscious thought, becomes tacit knowledge and unconscious. Is that consciousness nullified as Ross writes on page 76? I wrote a note 'reflection as hesitation'; also prompted to think about intution (p.83) and our word uses in 'retardation' (which here is no problem at all - in physics and complex sciences/systems. Again the 'principle of least action' arises (p.82). With more physics and cosmology to follow, it helps a little that 'manifold' has landed begging to be understood across the contexts. Bill Ross notes how Delueze and Michel Serres used the game metaphor [Game analogy #1]. Again, lifting this to a scribble 'Health-Illness is quite a game'! This will be the subject of a post soon. In England at least the law and manifold on health (being productive) and illness has been utterly disrupted. The game-table has been kicked over, by those in society who still able? New spaces, and canvases are needed. Kantian thought and interpretations are added to Leibniz. A heady mix but clearly essential as Bill Ross's critique is developed. 

 

The book was a must-read, as in the contents: Complexity (with a presentation next month), cosmology, Serres, and Claude Shannon. In Game Analogy #2, "Communication is understood here to encompass much more than meaningful exchange; all phenomena 'communicate'". p.85. I couldn't agree more with with these 'games', this thought being 'situated within the purchase of information theory' (p.86). Bizarrely (or not), in the same year two papers:

Jones, P. (1996) Humans, Information, and Science, Journal of Advanced Nursing, 24(3),591-598.

Jones, P. (1996) An overarching theory of health communication? Health Informatics Journal,2,1,28-34. 

Ross explains the global view of Michel Serres when it comes to 'information'. This entranced me, and I only scratched the skin:

Jones, P. (2008) Exploring Serres’ Atlas, Hodges’ Knowledge Domains and the Fusion of Informatics and Cultural Horizons, IN Kidd, T., Chen, I. (Eds.) Social Information Technology Connecting Society and Cultural Issues, Idea Group Publishing, Inc. Chap. 7, pp. 96-109.

Here there's a pointer to the cosmology to follow - Ross is true to the title. I have let most of the Astronomy Yearbooks go, but retain a few. Not just for key birth-years, but articles that are well written and researched historical snapshots. Here, Bill Ross discusses the game of Cepheid variables and their significance in mapping the universe. Truly, fascinating. Weaver's three levels of salient action are listed. Threads are tied too, with conclusions offered. These rules are reappraised, physics ever present. In light of one of the above papers I should revisit Serres, and Leibniz; the search for 'overarching explanatory power' (p.91) is ongoing. This game draws on Serres invitation to imagine a diagram, a network of nodes, channels, and propositions. This tabular formulation and its relations for me, spans the history of economics (Quesnay's tableau), the current state of economics (human values), and next (mathematical?) steps for Hodges' model. So many questions here: surely node  can't be an axis? I felt like Hansel, picking up sweets, Cartesian lines, scalene forms, thresholds, coming across hoops to jump through through to terminal equilibri. As you walk the sound of the thalweg, downstream... where Bergson features once again.

 

Reading Ross, over several months coincided with several key themes gaining in personal coherence. Bayesian ideas as might be applied to Hodges' model, even if in a naïve way (c/o feedback on draft notes). The remainder of chapter 3 includes time (thought), percept (space), to close with Deleuze's Ideal Game. I looked up Cortázarian Hopscotch https://en.wikipedia.org/wiki/Hopscotch_(Cort%C3%A1zar_novel), as the preface is titled. Ross reflects on the Ideal Game (does it exist, for Deleuze, only in thought?), and the distinction between 'domestic' chance (Baysian) and radical contingency belonging to the clinamen. In response to 'physical action and and the thought being on the same continuum', don't ask (please!), but I scribbled: 'corridor care' - a dangerous game, far from ideal. Plus, bird's using quantum entanglement to navigate. 'Kant's chaotic manifold', I will also investigate for next month(?).

Chapter 4 'Order as Complexity' proved most relevant. Every page is touched by graphite.

Deleuze has a 'blind spot' (p.111), something that Hodges' model seeks to ameloirate. But then of course at the model's center (nexus - as noted) that decussation of the axes invites a darkness of its own. If Hodges' model assists forethought and foresight  While inviting complexity, this interdisciplinary palette can also facilitate trandiscipinary sense-making. 'Magnitudes of intensity' reminded me of logarithmic thresholds within our perceptual apparatus. This is like reading Serres. A flow of punctum, simultaneity, delay (again) but its contribution to causal series, and Aionic time. I was taken (frequently)  to plane, person, personhood, chronicity, scales, local to global to glocal.

'BwO' (p.117)? That's 'body without organs: DELEUZE, GUATTARI a thousand plateaus - capitalism and s c h i z o p h r e n i a'.

There is a 'corner' amid those thousand plateaus. n.b. to self - 'triangulation always needs one other'. I cannot resolve the frameworks as yet, scientific - otherwise or otherwhere; but you can take flight from here. Physics takes it place as 'complexity begets complexity'. Bill Ross utilises well-recognized sources, Penrose, Kauffman, Kolmogorov and Bohm.

As with the frameworks internal and external complexity must be untangled 1-4 (p.124?). I can laugh now, did I really try to marry up Order  - Disorder :: Simple - Complex (complicated?) to the domains of Hodges' model? So often reading philosophy, you feel an imposter playing games with words, as in: 'different similarities' and 'similar differences' (p.125). But of course, this is serious scholarship. Especially, when it involves lines, a rough circle, segments and dimensions: disorder becomes different degrees of order. Page 126 delivers Deleuze in spades, Ross pulls his thoughts together. It is fitting for me that Ross closes chapter 4 with a nod to transdisciplinarity.

Chapter 5 deals with symmetry and disymmetry; indifference and difference; limits and non-locality. There is an argument to follow (p.133). With 'group theory' mentioned on p.131, I've a lot of things to 'look up' [topology too]. Despite appearances I recognise the lack of symmetry in Hodges' model. This is what the situation does (practice) and means (theory): 'There is no reason under the sun which can rely on perfect symmetry' (p.135).  Where do/can we locate 'spooky action at a distance' in Hodges' model (p.140)? 

The Higgs role! Who knew? 'the speed of light. It represents a retardation.' Thanks Bill Ross, fascinating pp. 135-174. Plus, axes too. Note to self: when we die do we 'simply' set sail on the Dirac Sea? Attending the Bill Ross Memorial Workshop – BSP Special Event 2025 last September:

https://hodges-model.blogspot.com/2025/09/bill-ross-memorial-workshop.html

the esteem .. and love .. that Bill Ross engendered in the people that knew him. The preface refers to chats in university cafes. How I wish. I wonder what Bill would have made of Hodges' model and the ongoing project here? Vitally, I get a distinct sense that he would have found time to listen ... 

'Bill Ross (1964 – 2022) had interests ranging widely across contemporary philosophy and culture, with a particular interest in the relations between science and philosophy. As managing editor, he was the driving force behind Clinamen Press, which in the early 2000s published new works by contemporary philosophers, and English translation of important works by continental philosophers such as Henri Bergson, Gaston Bachelard and Michel Serres. He completed his PhD in philosophy at Staffordshire University, where he taught on the MA in the Philosophy of Nature, Information, and Technology. Bill had a lifelong passion for the connections between science and philosophy, on which he had published several important articles. Bill was working on a monograph on the philosophy and science of Deleuzian cosmology, which was has been posthumously published by Edinburgh University Press. This event is to celebrate Bill’s book and his life, and to allow his friends, his colleagues, and anyone interested in his work or the topics and issues addressed by his work to continue the conversation that Bill’s work inspires.'

https://www.thebsp.org.uk/bill-ross-memorial-workshop-deleuzian-cosmologies/

 

Many thanks again to Edinburgh University Press for my copy - a keeper! Bill Ross RIP.

 

Bill Ross (2024) Order and the Virtual: The Philosophy and Science of Deleuzian Cosmology. Edinburgh: Edinburgh University Press.
https://edinburghuniversitypress.com/book-order-and-the-virtual.html

Joining the digital dots across primary care and integrated care

My partner and I both received a letter today from our respective GPs. An invitation for a 'FREE LUNG HEALTH CHECK'.

Overleaf is an information sheet in landscape about the health check, plus three more sides of A4, similarly formatted - inviting trifold presentation.

After the 'Re. ......' an opening sentence asks: 'Have you ever been a smoker?'

Suddenly, I was dragged backwards through his-tory (some things don't change); not one history, but several:

INDIVIDUAL

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    INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

|

GROUP

My personal and life experience  and not just since my teens . . .

The letter states: **If you have never smoked, you are not eligible for this service**

My mother and father  smoked when I was a child and my siblings.    They got the message early 1980s.    'Society' smoked back then!     Once old enough, I refused to go to the corner shop.   Into the 1990s, patients, smoking (some chain-smoking) on admission, long-stay and other clinical areas. As a community mental health nurse, I learned diplomatic and health promoting skills when in the car, giving a patient a lift to hospital. And, when visiting their home where I was, of course, usually, a guest.

I wondered what has happened to the GP's records? To the primary care clinical record ? The custodians of my health record, that they should need to ask that question?    Or, does confidentiality tie some bureaucratic knots?   Where is 'integrated care' and its driver 'clinical informatics'?  The letter included the NHS Number.    Don't get me wrong, I/we appreciate the obvious effort here, even if the chronology is confusing, or,  speaks of afterthought? The letters are dated 19/06/2025. I must admit I haven't accessed my GP record, checking it for accuracy.   If anything, this is a prompt to do so. And seek a general medical.

Previously: 'smoking' : 'winwick'

Biology, axioms, teleology and knowledge c/o Cox & Forshaw (2012)

'Teleological ideas generally have a rather bad reputation in science, and it's easy to see why. In biology, a teleological explanation for the emergence of complex creatures would be tantamount to an argument for the existence of a designer, whereas Darwin's theory of evolution by natural selection provides a simpler explanation that fits the available data beautifully. There is no teleological component to Darwin's theory - random mutations produce variations in organisms, and external pressures from the environment and other living thing determine which of these variations are passed on to the next generation. This process alone can account for the complexity we see in life on Earth today. In other words, there is no need for a grand plan and no gradual ascent of life towards some sort of perfection. Instead, the evolution of life is a random walk, generated by the imperfect copying of genes in a constantly shifting external environment. The Nobel-Prize-winning French biologist Jacques Monod went so far as to define a cornerstone of modern biology as "the systematic or axiomatic denial that scientific knowledge can be obtained on the basis of theories that involve, explicitly or not, a teleological principle".

As far as physics is concerned, there is no debate as to whether or not the least action principle actually works, for it allows calculations to be performed that correctly describe Nature and it is a cornerstone of physics. It can be argued that the least action principle is not teleological at all, but the debate is in any case neutralized once we have a grasp of Feynman's approach to quantum mechanics. The ball flying through the air 'knows' which path to choose because it actually, secretly, explores every possible path.' pp.52-53.

Cox, Brian, and Jeff Forshaw. (2012) Quantum Universe, the: Everything That Can Happen Does Happen. London: Penguin Books Ltd.

See also: 

Jacques Monod - https://www.informationphilosopher.com/solutions/scientists/monod/

Harrison, Peter. 2022. 'The History of Science and Theology', St Andrews Encyclopaedia of Theology. Edited by Brendan N. Wolfe et al. https://www.saet.ac.uk/Christianity/TheHistoryofScienceandTheology

Greslehner GP. "Molecular Biology"- Pleonasm or Denotation for a Discipline of Its Own? Reflections on the Origins of Molecular Biology and Its Situation Today. Biomolecules. 2023 Oct 12;13(10):1511. doi: 10.3390/biom13101511. PMID: 37892193; PMCID: PMC10605324.

Previously: 'axiom' : 'biology' : 'corner'

'Thinking outside the box ...' iii by Amber Javis

Third response to a blog post by Amber Jarvis on The Mental Elf:

Thinking outside the box: alternatives to standard inpatient mental health care

Amber's post considers a study by:

Griffiths, J. L., Baldwin, H., Vasikaran, J., Jarvis, R., Pillutla, R., Saunders, K. R., … & Johnson, S. (2025). Alternative approaches to standard inpatient mental health care: development of a typology of service models. International Journal of Mental Health Systems, 19(1), 1-13: https://pubmed.ncbi.nlm.nih.gov/40247283/

A Community Psychiatric Nurse since 1985, on first contact patients were often upset initially at the prospect of a visit. Not the fact it was a nurse, but a psychiatric, 'mental' nurse. If the patient was OK about it, their family may have had qualms. Discretion was always exercised, essential in terms of maintaining confidentialty. Not infrequently, as a team we had a conflict of interest. A colleague already had a client a few doors down; or they lived around the corner. Socio-politically, there was never an issue back then with shop fronts, but homelessness has a long history of course. I've worked in intermediate support, visiting someone 2-3 times in a day. That continuity helps, in contrast to the experience of older adults in social care. It could be that the potential stigma elicited by intensive home care is now attenuated by:

• The public's increased awareness mental health & illness;
• The fragmentation of neighbourliness means people really aren't interested?

In the conclusion on Griffith's et al's study Amber notes:

'The authors’ classification of alternative service models could help planners and commissioners understand ‘the whole range of options’ when deciding which improvements to prioritise and invest in.

However, future studies should investigate the implementation challenges surrounding these alternative models – that is, what might make certain models easier or more difficult to introduce? Research investigating their effectiveness in practice is also required – are there particular models that are better suited to certain individuals, at particular times? As the authors put it: “what works best for whom, when and how”!'

The government in England has launched a trial regards people who are sick, and their work status:

'GP surgeries in England can offer advice to patients on getting back to work, including career coaching or exercise classes, as part of a pilot project to reduce the number of people who are signed off work sick.

The aim is to help people return to the workplace more quickly to reduce the length of time they need fit notes - better known as sick notes.

These are issued by health professionals if a patient is unwell or cannot work for more than seven days.

A total of £1.5m is being made available to 15 regions in England, and will be shared between GP practices in these areas to hire coaches or occupational therapists to support patients in their return to work.'

Hugh Pym, Health editor: https://www.bbc.co.uk/news/articles/cwyx880d1w8o 

Individual

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      INTERPERSONAL    :     SCIENCES               

HUMANISTIC  --------------------------------------  MECHANISTIC      

 SOCIOLOGY  :    POLITICAL 

|

Group

Career coaching Exercise classes Counselling Reduce time spent 'ill - sick - off-work' Motivation - Mindset	FIT - SICK: physically only of course! Seven days What can't I do? What can I do?
Social Prescribing Occupational Therapists Physiotherapist Support workers Horticultural groups Local history	FIT NOTES - SICK NOTES £1.5m across 15 regions Policy Welfare budget Behavioural Economics Integrated Care & Social Policy

Given the rise of mental health related provblems in the population, some might argue that increased awareness of, and education about mental illnesses is part of the problem. But this isn't literacy then?

With the standing of the mental health nursing curriculum called into question, policymakers have some serious decisions to make. Social prescribers and care navigators are not the only people preoccupied with signposting. Griffith et al. write:

'Inpatient care is also costly; even though only 3% of people in England accessing mental health care in 2018/19 received inpatient mental health care, National Health Service (NHS) trusts in England still invest more in inpatient than community services [8].'

Hodges' model: Axes & Domains

You can appreciate just how far away prevention and a health literate population truly are. Budgets will have to be re-directed. Now that is 'care-ordination'.

Griffith et al. and Amber's response, calls care that is simultaneous person-centred and service-centred. 

In Hodges' model it is as if the vertical axis, is turned and the 'individual' aligned with the humanistic (person-centred) and group - the mechanistic (service-centred) axis. This gives us self-care, individualised healthcare, personalised medicine through to population health.

Griffith does not venture into literacy and education (not their study's purpose, of course); but using Hodges' model, we can see two critical related issues. In addition to reducing the time a person is physically, and mentally indisposed, unwell, ill, sick ...

1. We need to improve the lot of children excluded from school;
2. Seriously address the determinants of health socio-politically.

'Thinking outside the box ...' i

ii 'Thinking outside the box ...'

Hybrid: Seminar & Tetralogic Model

Free Hybrid Seminar Oct 2nd - Personal Welfare Decisions:
Year in Review & Future Developments

individual

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INTERPERSONAL : SCIENCES

humanistic ------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group

my corner 'I' The person - self The person's - mental state, mental capacity orientation (time, place, person) continuity -  mental illness identity (advanced?) choice ... my decisions? PSYCHO-	physical environment place, time embodiment - sense of self deprivation of liberty anticipated future developments probability silk my body?!
next of kin family friends carers Social Housing Community Care Residential care sector personal welfare decisions	-POLITICAL UK - EU Politics European Convention on Human Rights Law - Case Law Solicitors Barristers Silk Judge Court of Protection Decisions of the Court Mental Capacity Mental Health Law 🌍

My source: https://x.com/hfp91/status/1837526633235833079

'Slugfields Luxury Prison' c/o Isabel Rock - artist

"In November 2022, I spent a month on remand at HMP Bronzefield for my part in the Just Stop Oil protests on the M25. I was happy to go to prison for something I know is morally right. Drawing in prison became my saviour against the monotony. I rarely draw from life anymore, but we were given a little notebook in our 'welcome' bags of grey tracksuits, pastel pants and toothbrush." p.19.

"This drawing is Slugfields Luxury Prison, (152×120cm) the institutional blue doors, plastic chairs, toilet in the corner and the panoptican architecture mirror that of Bronzefields. It's not quite finished yet, but it's been a cathartic experience to draw some of my thoughts on prison life and incarceration by the state." Instagram (and image source).

INDIVIDUAL
  |

     INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

|

GROUP

	Slugfields Luxury Prison, (152×120cm) by Isabel Rock

Rock, I., 'Drawn Behind Bars' PRINTMAKING TODAY, Autumn 2023, Cello Press Ltd. Volume 32, Issue 127, p.19-21.

With thanks to Isabel Rock.

"Conceptual: only worth the paper it's written on"

Financial Times. June 9, 2012, p.11.  

"How do you prove you own a work of conceptual art? This is an interesting issue in today's art market, with the trend towards the dematerialisation of art, and the primacy of the idea over its physical presence.

For example, the late US artist Félix González-Torres's works include "Candy Spills", in which wrapped sweets are piled on the floor or in a corner, to be taken and eaten by viewers. When the pile has gone, the owner of the work replenishes it.
So what stops anyone making and selling their own "Candy Spill"? The answer is the certificate of authenticity issued by the artist or their estate. This scrap of paper is, in fact, the only proof that the work of art genuinely belongs to you, and this is actually what you buy and sell."

 

INDIVIDUAL

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     INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

|

GROUP

cognition, reasoning imagination, creativity concepts, ideas personal aesthetics subjective - personal meaning "This is mine!"	materials physical objects dimensions, form, properties entropy: time, decay - disorder change
art and arts culture - 'what is art?' Art criticism Collective aesthetic	'the Market' Economic Worth / Value Values Proof of ownership law, intellectual property / ©

For further context - please see:
https://artquest.org.uk/artlaw-article/authenticity-certificates-value/

Adam, G. "Conceptual: only worth the paper it's written on". Financial Times, The Art Market. Collecting, June 9, 2012, p.11.

Sorting / clearing books and papers ongoing. Break next week - inc. reading.

Tuskegee Healing, the Moral Determinants of Health, and the Ethics of Research on Black Health

My source: SpiritOf1848 list - Lachlan Forrow

Research Ethics Consortium: Tuskegee Healing, the Moral Determinants of Health, and the Ethics of Research on Black Health

February 17, 2023 | 12:30 - 2 p.m. ET | Live on Zoom | Register Here

The USPHS Study of Untreated Syphilis in the Negro Male at Tuskegee and Macon County began in 1932, after US Public Health Service doctors recorded a 39.8% prevalence of syphilis among patients seen in Macon County, Alabama during a treatment study in one corner of the county. While these data might have raised many possible research questions, USPHS doctors chose to focus on the natural history of untreated syphilis.

They not only denied participants the treatments available in the 1930’s; they also chose to continue to study untreated syphilis long after highly-effective, inexpensive, and extraordinarily safe treatment with penicillin became widely available. While the research methods they used are now universally condemned, far less attention has been given to more fundamental questions about the ethics of research, including:

What should the goals of research even be? Who should decide those? What are the most crucial ethical characteristics of relationships between investigators and research subjects?

Introductory Remarks:

• Carmen J. Thornton, MPH, MCHES
  Director of Research, Development, and Workforce, American Academy of Child & Adolescent Psychiatry
  Consultant, Voices for Our Fathers Legacy Foundation
  Granddaughter of Fred Tyson, subject in USPHS Syphilis Study at Tuskegee

Presenters:

• Susan M. Reverby, PhD
  Marion Butler McLean Professor Emerita in the History of Ideas
  Professor Emerita of Women's and Gender Studies, Wellesley College
  Author of Examining Tuskegee: The Infamous Syphilis Study and Its Legacy
• Jesse Milan, Jr., JD
  President and CEO, AIDS United
• Wangui Muigai, PhD
  Assistant Professor, Brandeis University
  Greenwall Faculty Scholar, class of 2025

Moderator:

• Lachlan Forrow, MD
  Director, Ethics & Palliative Care Program, Beth Israel Deaconess Medical Center
  Lecturer on Global Health and Social Medicine, Part-time, Harvard Medical School
  President, The Albert Schweitzer Fellowship

Commentator:

• David Augustin Hodge, Sr., DMin, PhD
  Associate Director of Education and Associate Professor, National Center for Bioethics in Research and Health Care, Tuskegee University

Support provided by the Oswald DeN. Cammann Fund at Harvard University.

This will build from two November 2022 events (see their flyers below) commemorating the 90th/50th/25th anniversaries of the USPHS Study of Untreated Syphilis in the Negro Male at Tuskegee and Macon County, the first organized/hosted by the National Center for Bioethics at Tuskegee University, the second organized/hosted by CDC (see details and video of that here; the first 2min30sec include Dr. Termika Smith’s wonderful intro [60 seconds] and President Biden’s remarks [90 seconds]. 

I would also strongly recommend watching ~5 minutes starting at 11min45sec – Mrs. Lillie Head, daughter of Fred Tyson, one of the men in the Study, and founder/leader of Voices for Our Fathers Legacy Foundation, explaining what the Study was really about (i.e. the moral issues were racism, dehumanization, etc. etc., not just “failures of informed consent”). 

For our Feb 17 session, after presentations by Carmen J. Thornton (Lillie Head’s daughter, i.e. granddaughter of Fred Tyson) and Susan Reverby (arguably the leading historian of the Study), and then presentations about applying this framework to 3 concrete areas of severe and ongoing “Black health disparities” (Jesse Milan, President/CEO of AIDSUnited on HIV/AIDS; Wangui Muigai on the history and current realities of Black maternal/infant mortality; and I hope [not yet confirmed] Rev. Jeffrey Brown [co-chair of Embrace Boston] on gun violence) the “Commentators” will be Dr. David Hodge, Associate Director of the National Center, who organized their Nov 2022 event, and Dr. Termika Smith, who organized and moderated the CDC event. Then Carmen J. Thornton, as granddaughter, will have closing words -- what her grandfather might say, and what she herself thinks, about MLK’s question: Where Do We Go From Here? 

Art as 'social media' 1923

Music, Health and Character

"The varied picture presented by life is viewed by each individual through the transforming medium of his own private consciousness. Our judgements are biased, being coloured, inevitably, by our personal  interests, occupation and experience. To the physician has been entrusted the health of the body; his outlook upon the world is tinged by his desire to prevent disease by eliminating abnormal predisposing causes. So close and so intricate is the union of mind and body that modern medicine recognizes the necessity of right thinking and right conduct for the highest development of the body. Hence, from his unique corner of advantage, that of the sympathetic confidant of innumerable life tragedies, the physician views with dismay the ruin of individuals, and the disaster brought on families and entire communities by frequent contact with the morbid, even at times the depraved teaching which is embodied in many branches of art with lighthearted irresponsibility. More and more profoundly are the medical psychologists impressed by the creative and the destructive power of such intangible forces as ideas. More and more urgently, therefore, does modern medicine plead, in its capacity as guardian of the public health, for the improvement of mental and moral conditions. With wiser education people will demand that Art shall be pure, sincere and life-giving, and that artists shall value seriously their responsibility and their power to mould the character of the community. The true artist always aims high and discourages the association of art with all that is trivial, insincere and debasing." p.225-226.

Agnes Savill (Agnes Forbes Blackadder), Music, Health and Character, London: Bodley Head Limited. 1923.
(Book cover: AbeBooks)

The view from Wigan Pier* ...

or, Greetings from WN4.

Camilla Cavendish's focus in the weekend FT is health, social care and related policy. In a recent opinion piece on junk food she writes:

"Which is more Orwellian, I wonder: adding 1p to a bag of crisps, or letting companies go on turning us all into junk food addicts, while the cost of treating diet-related diseases soars? Long before we were engulfed in a torrent of junk, George Orwell wrote in The Road to Wigan Pier: 'The peculiar evil is this, that the less money you have, the less inclined you feel to spend it on wholesome food.' Now, processing techniques have made unhealthy food cheaper than many healthy alternatives."

Several months ago, reading a book review: Doom looped, by Douglas Alexander on Niall Ferguson's Doom: The Politics of Catastrophe, (Life&Arts, 1-2 May, 2021, p.9) the conclusion closes:

"The inherent unpredictability of what lies in wait for us all around the next corner means that, notwithstanding Ferguson's brilliance and breadth of scholarship, this immensely readable book is a better lens than it is a compass."

From the local and national to the international and beyond - we must encompass  planetary health.  Even on a rainy day, the view from Wigan Pier is clear: Hodges' model can provide a compass and a lens.

Cavendish, C. (2021) It is time to stem the tide of junk that reaches British plates, A tax on sugar and salt in food would be a global first and is more necessary than ever. Opinion, FTWeekend, 17-18 July, p.12.

'lens' on W2tQ 

'compass' 

'corner(s)' [ How many corners are there in Hodges' model? How many when you add 'the spiritual'? ]

'line-of-sight'

*You can have your pie and eat it! ;-)

'Clean tools' - fit for Conceptual Engineering?

Posting previously news of a conference on 'Conceptual Engineering' I was drawn and try to follow the following series:

Conceptual Engineering Seminar | Simon Blackburn (Cambridge): TBA 

March 30 @ 3:00 pm - 5:00 pm 

ABSTRACT. — When I hit upon the term ‘conceptual engineering’ in the Introduction to my book Think, I suppose I thought of it as simply a cute way of introducing what philosophers do. I had no idea that the term had already been used, although I have subsequently learned that it was. I have therefore been surprised that books and seminars have subsequently been devoted to the idea: it is as if books and seminars were simply entitled ‘Philosophy’ rather than directed at particular problems within philosophy. In my talk I hope to go further into that and try to understand why it happened. 

Yesterday, Simon Blackburn cited Austin (1956) and the need for 'clean tools', which led me to the following source*:

"First, words are our tools, and, as a minimum, we should use clean tools: we should know what we mean and what we do not, and we must forearm ourselves against the traps that language sets us. Secondly, words are not (except in their own little corner*) facts or things: we need therefore to prise them off the world, to hold them apart from and against it, so that we can realise their inadequacies and arbitrarinesses, and can re-look at the world without blinkers. Thirdly, and more hopefully, our common stock of words embodies all the distinctions men have found worth drawing, and the connexions they have found worth marking, in the lifetimes of many generations: these surely are likely to be more numerous, more sound, since they have stood up to the long test of the survival of the fittest, and more subtle, at least in all ordinary and reasonably practical matters, than any that you or I are likely to think up in our armchairs of an afternoon - the most favoured alternative method."

*my emphasis

Simon's talk of 'clean tools' prompted me to reflect:

The assumed neutrality of Hodges' model. As noted on W2tQ previously, Hodges' model is an invitation to start with a new slate. To leave behind bias and prejudice, to assure unconditional positive regard and a non-judgmental approach and attitude.

'Engineering' is usually conducted within a dedicated physical space. Apprentices will soon be familiar with the discipline of leaving the work environment clean and prepared for the next day. They will learn that tools have their place (even on the screen). Tools themselves also need care; so don't be care-less.

If Occam's razor is a preparatory rule for conceptual hygiene, perhaps we can take this further, or at least propose an addition? There is a 'rule of forceps' (which, it might be argued, is person-centred, or clearly patient-centred?) but not only are forceps a tool, we can utilise a divider too.

In use, Hodges' model suggests and facilitates dichotomous thinking. The forceps may help grasp the the key parts - the polarities of a situation. The divider may serve to help us to weigh and measure the 'distance' of two concepts, especially if they seem to be grounded across two of the model's care (knowledge) domains.

So Hodges' model may have a role in 'conceptual engineering', variously as a dialectic divider or dialectical forceps?

Austin, J. (1956). A Plea for Excuses: The Presidential Address. Proceedings of the Aristotelian Society, 57, new series, 1-30. Retrieved March 30, 2021, from http://www.jstor.org/stable/4544570Austin, J. (1956). A Plea for Excuses: The Presidential Address. Proceedings of the Aristotelian Society, 57, new series, 1-30. Retrieved March 30, 2021, from http://www.jstor.org/stable/4544570

There is a legal case of historic interest also described in the Austin's paper.

Pick your corner carefully ...

individual

|

INTERPERSONAL : SCIENCES

humanistic ----------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group - population

Of all the corners you can pick* take care ...
	... some are even more 'political' and expressive of power, individually and collectively, than when exercised right here.

 

Ack. Source:

(1/) In hospital today, whilst in a lot of pain I spelled my name 3 times for a receptionist who kept sighing; eventually rolling her eyes she said loudly "You're confusing me with that name. Come explain it properly in that corner!" So many issues with what happened here...

— Adiba Sultan (@AdibaSultan) [No longer available.]

 

*I remember at school 1970s - our drama teacher highlighting the people who have social awareness and those who do not. 'Social awareness' covers a wide range of attitudes, behaviour, manners,  literacies, intelligences ... and with ongoing unrest, campaigning, activism, legislation, policy and human rights we  have made progress. A counterpoint and sadness in the 21st C. is that - as ever - there remains much to do: many people [still] can not exercise a choice in terms of the corners they would like to reach.

Book Review: iii Mathematics and Art: A Cultural History

Mathematics + Art

Chapters 2 and 3 on proportion and infinity and chapter 7 on symmetry concern foundational topics in mathematics and also the arts. From antiquity through to modern day the ideas are interwoven within and across personalities, history and the development of thought and a never ending quest for knowledge and meaning.

The diagrams in chapter 2 work very well illustrating the literal transformation of the representation of 3D space on a 2D plane. Linear perspective then presented it own challenge for artists, the human figure correctly proportioned against architecture that can dominate space, as intended, but on a canvas?

I have long laboured the point that in Hodges' model, it takes physical and emotional labour to put the patient (person, carer, student, ...) at the center of the model. In art, Alberti suggested putting the vanishing point in the center of a painting to achieve an overall symmetry (p.81). We realise of course that comprehensive, non-judgemental, person-centredness also relies on political labour too.

In chapter 3 on infinity, the 'frightening' aspect of the concept is highlighted from the outset in the work of Cantor, even before discussing rational and irrational numbers. As much as we clearly seek to reduce phenomena, it is fascinating; the human drive to unify, synthesize and discern some higher Absolute order. The existence of free will was subject to question (C. 19th) and is still debated today, with probability calculations and quantum mechanical additions. Although we might understand a concept in a certain disciplinary context, the conjunction of disciplines (art and mathematics) and the meaning of terms abstract and objective (and hence subjective) are instantly and usefully perturbed. That's what I enjoyed about reading this.

In the first post on Gamwell's book I suggested the (oh so real!) mystery of mathematics for me. The book could have been a challenge in terms of explaining complex mathematics, but this 'tome' rewards rather than confounds the reader. In chapter 3 you will find 'set theory' and Cantor's Actual infinity. At the risk of contradicting myself, aleph-zero, aleph-null et al. are worth (require) re-reading. Gamwell provides the titles of other key texts, some dating to the earliest writings and with some background. Gamwell refers to friar Giodano Bruno and the plurality of worlds, another very early reference to SETI. A reminder of a book to pick up again, with Leopardi Giacomo in the Zibaldone: infinity, (other) beings and nihilism too?

Like you perhaps, I have seen this engraving many times:

Camille Flammarion:
L'atmosphère météorologie populaire.
Paris 1888

As if often the case, there is more to this than meets the eye.

Thanks to Gamwell (p.126) I can see Hodges' model not only as "the place where four roads meet" but:

"In this nineteenth-century popular science on meteorology, an anonymous engraver depicted a medieval cleric who, like Bruno, imagined that beyond the fixed stars on the dome of the heaven were other suns, other worlds, and, according to a vision of the Hebrew prophet Ezekiel, a spirit-filled chariot with "a wheel intersecting a wheel" (shown in the upper left-hand corner) that could magically roll in four directions...".

individual

|

INTERPERSONAL : SCIENCES

humanistic ----------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group - population

	Cantor's real number axis, he called "the continuum", it is dense. p.123. statistics
	STATISTICUS (Latin: 'of the state') p.120.

More to follow ...

Lynn Gamwell (2016) Mathematics and Art: A Cultural History. Princeton, New Jersey: Princeton University Press. ISBN: 9780691165288. p.283.

(Thank you to PUP and I must add John Wiley for the review copy - more to follow.)

Source image:

Camille Flammarion: L'atmosphère météorologie populaire. Paris 1888.

https://www.researchgate.net/publication/267625072_Feasibility_of_Parallaxes_with_CoRoT

The Art & Science of Health: [conceptual scraps i]

The role that both art and science have to play in health, medicine and nursing is recognised by all. The distinction can be made in a great many ways using Hodges' model. Now: there is an exercise for a new group of student nurses ... ?

As I hope is evident in numerous blog posts and subjects of relevance to h2cm, notably, conceptual spaces and threshold concepts, concepts are a basic element in nursing scholarship and debate within art.
 
In the FT Weekend June 9-10, 2012, p.11 I read: "Conceptual: only worth the paper it's written on" (Georgina Adam). From a healthcare perspective, Adam's opening question seems fairly innocuous:

"How do you prove that you own a work of conceptual art?"

Amid the ongoing revelations involving user's personal data and the governance and values of social media companies lies the question of ownership. First though, back to Adams:

"This is an interesting issue in today’s art market, with the trend towards the dematerialisation of art, and the primacy of the idea over its physical presence.

For example, the late US artist Félix González-Torres’s works include “Candy Spills”, in which wrapped sweets are piled on the floor or in a corner, to be taken and eaten by viewers. When the pile has gone, the owner of the work replenishes it. So what stops anyone making and selling their own “Candy Spill”?

The answer is the certificate of authenticity issued by the artist or their estate. This scrap of paper is, in fact, the only proof that the work of art genuinely belongs to you, and this is actually what you buy and sell.

So losing it is a disaster."

The contrast of this within health care and its 'record' is quite stark. There are at least two ways to  distinguish between the scraps of paper we use ...:

to be continued...

ii Yes, Nursing is both an Art and Science but ...

The value and provenance of 
nursing, 
nursing's benefits and 
high quality nursing care 

cannot just be a matter of 
record*
on paper, screen, media 
or artificial neural network ...

individual

|

INTERPERSONAL : SCIENCES

humanistic ------------- NURSING as ART & SCIENCE ------------ mechanistic

SOCIOLOGY : POLITICAL

|

group

Nursing ...  and its many dimensions ...	"How do you prove that you own a work of conceptual art? This is an interesting issue in today’s art market, with the trend towards the dematerialisation of art, and the primacy of the idea over its physical presence."
"For example, the late US artist Félix González-Torres’s works include “Candy Spills”, in which wrapped sweets are piled on the floor or in a corner, to be taken and eaten by viewers. When the pile has gone, the owner of the work replenishes it. So what stops anyone making and selling their own “Candy Spill”?"	"The answer is the certificate of authenticity issued by the artist or their estate. This scrap of paper is, in fact, the only proof that the work of art genuinely belongs to you, and this is actually what you buy and sell."

*
1. Often heard: "If it is not written down, it never happened."
2. Nurse registration.
3. The Uniform ™

Georgina Adams, Conceptual: only worth the paper it's written on, Financial Times, Life & Arts. June 9, 2012 p.11.

Book Review: [ii] An introduction to Health Research Methods

Where were we from Part [i]? For the book contents listing look no further. The publisher's site also provides sample pages.

For part ii we are up to chapter 14. Correlation studies, also known as aggregate or ecological studies had me scurrying to the index. While such studies usually rely on secondary analyses I thought about the power of social media to disrupt such distinctions. 'Social media' is there p.165 and this would be primary 'live' (the idea of a feed sounds 'live', but then web crawling can be quite retrospective) or secondary and might deserve a chapter of its own in. Despite such queries figures proceed to inform the analysis of correlation pp.97-100.

At step 3 we are still under a third way through  the text, excluding the glossary and index. Chapter 15 explains research timelines and protocols. While trying to formulate my own research question, I created a research plan and Gantt chart (figs 15-1 & 15-2). This prompts me to revisit the exercise as an independent scholar with the decade long aspiration to create a new website. The treatment here is aimed, of course, at research teams with responsibilities and a principal investigator. Figure 16-1 on sample populations and how they are derived I sometimes share with students on placement as I encourage them to be researchers. They should always be asking questions, as students, at their job interview and a new post provides an ideal opportunity to hear problems, issues, uncertainties. Many managers miss this - a fresh pair of eyes.

Vulnerable populations deserve and are given specific mention. Chapters 17 and 18 covers primary research concepts, such as, sample size, power estimation, reliability and validity. The systematic approach throughout the book is evident here. My initial note about lack of whitespace sees Jacobsen advocating for whitespace in questionnaire design. This advice flows into surveys, interviews and other assessments. The research essential of Boolean search is described with the process of a systematic search strategy, also allied with Forest and Funnel plots. Do take time with chapter 25 on writing research grants, even if you are an individual. It is obvious, but your financial situation can greatly affect your staying power in a programme of study that incorporates research, or is research led. Personal circumstances can change.

In step 4 if research has its quarry face, then we meet it here in (what can be) the hard-grind of data management (chapter 26) code books, data entry, data cleaning and data coding. The maths is invariably explicit in chapters 28 and 29 on descriptive statistics, regression analysis. Here the figures and text really do go hand-in-hand. If baby should never be in the corner Step 5 reminds us that research should never just be stuck on the shelf. In reporting findings you will find posters, conferences, presentations and writing papers, citing sources, and seeing an article through submission, revision to publication. A chapter deals with success - or how to keep going which brings readers to end with a glossary that is not cross referenced but the index is thorough.

This is very good introduction and the title really reflects the aim and content. This is an excellent primer that you can return to after the paint is well dry. It will be a pleasure to pass this book on to a nurse working in research - clinical trials. As is often the case there is an online access code to additional course materials. I have not broken the seal but may add further comments if they follow. There are always other things that might be included. As research stresses literature is there a way to include literacy, to wrest health literacy from the fog of the research question? Visual methods are increasingly used and the comic format used for educational, and even presentation of theses and dissertations. Genomics and the advent of (medically) personalised care may demand additional knowledge for researchers of all levels.

The other thought I alluded to in part [i] does not affect my recommendation for this book; but it concerns the primary, secondary and tertiary forms of research, literacy and access to information. Yes, these have an established place in the research process and lexicon (inclusion/exclusion criteria, informed consent...) with a history to reinforce this foundation. But is there a problem as this research is supporting health systems that really must change. Does something further in research need to change? Where and how could we incorporate the quaternary view? Never mind a chapter: could that have a step all its own?

Part [i]

With thanks to Emma Phillips, Marketing Manager: Academic Class Learning.

Fallding: 'model'

"The ideal type, as a case of the heuristic, resembles what is now called a model. ... He [Nagel] makes model refer simply to the mental imagery with which we clothe our theoretical entities in order to have some pictorial grasp of them : ... essentially analogies, yet they do more than help us visualize; they help our thinking to unfold by taking it in new directions. 

[Model] is taken to mean a system of concepts that is useful in mapping the variables in a field under investigation. It may be a corner of a field or the whole field of the subject: a model may be of bureaucracy, for instance, or of society in general. ... in scientific work we do not start out with an empty mind, nor even with isolated hypotheses. We start with a guess about the whole structure of our universe of discourse. The coherence that goes into this system of concepts, a coherence whereby each concept is defined by the relationship in which it stands to the others, is analogous to explanation but is not explanation in fact. For it is not an account of reality as it has been experienced" (p. 510).

Harold Fallding. Explanatory Theory, Analytical Theory and the Ideal Type. In. Thompson, K. and Tunstall, J. (eds.): Sociological Perspectives, Penguin Books, Harmondsworth, 1971.

Excerpt from Harold Fallding. (1968) The sociological task. Prentice-Hall.

"Get in that corner! Now!"

"Which one?"

"Don't you be so hard-faced with me.
Go!"

individual

|

INTERPERSONAL : SCIENCES

humanistic --------------------------------------- mechanistic

SOCIOLOGY : POLITICAL
|

group

anxiety fear guilt hate	here - out of sight out of reach - over here this corner: out of earshot that corner
shame ridicule embarassment  alienation	bullying - abuse punishment injustice deportation

World Mental Health Day - Weeks, Months, Years (and Tears: or trying to find them)

Prompted by World Mental Health Day posted below are some thoughts related to each of the domains of Hodges' model in respect of mental health and health and social care in general.

individual

|

INTERPERSONAL : SCIENCES

humanistic -------------------------------  mechanistic

SOCIOLOGY : POLITICAL

|

group-population

Reflection is an important human ability. It can be variously described as - reasoning, problem solving, introspection ... but an ability of self-reflect and critique our circumstances in a balanced, mature, objective way is an important skill that should ideally be shaped like so many others in childhood. Education and health literacy matters. Evidence for reflection and reflective practice for nurses and other health professionals remains rather sparse and contested. There can be ethical challenges and assessment and measurement of reflection and reflective practice is problematic. Hodges' model can support individual reflection providing a framework to facilitate person centred, integrated and holistic care. Globally there is no generic conceptual framework. Here is a candidate!

The parity of esteem debate that is so often heard in the political domain, becomes a stark fact of life to the individual in their physical and mental health. The two must be integrated. Policy makers look to the SCIENCES domain to find the technical and analytical tools to study demographic trends and produce national statistics.  Health providers are increasingly having to deliver services for individuals and programmes for population health. Data and Big Data all contribute through national governments to regional centers and the WHO.

Far from the binary logic of maths and the technical wonders it gives rise to, here in the SOCIOLOGICAL domain the YES or NO to having next of kin, partner, family and friends is pivotal from a mental health perspective.  There is an irony that the size and stability of someone's social network is an indicator of their staying well; while social media can act as a force for good, or a negative force aimed at those vulnerable to bullying and abuse. Effective communication is situated and ultimately determined by context: personal, local, glocal and global.

In this domain, whichever corner you turn to, it is politicised: be it funding for services; the word 'recovery'; the very existence and acknowledgement of mental health allied to human rights and service provision; employment and welfare; policy for access, diversity, equity, gender, equality.... mental health is manifest with political dimensions. How are the needs of specific groups met, children, youths, women, men...? Mental health law is crucial for personal and public safety. How this is conducted and governed is a measure of a modern state and please note the distance from the INTRA- INTERPERSONAL domain at upper left.

Thanks to @MHChat and community for reminder #WorldMentalHealthDay #WMHD16